| BackgroundThe increased HIV infection incidence and the appearance of multi - drug resistance prompted the society to consider tuberculosis as a worldwide urgency, and its control has again become a public health issue. In non - HIV infected people, approximately 15% of the new cases of tuberculosis reported annually are extra — pulmonary, and, genitourinary tract tuberculosis was about 20%. Moreover, the diagnosis of genitourinary tuberculosis is difficult. The final diagnosis of genitourinary tuberculosis still depends on find the Mycobacterium tuberculosis ( MTB) in urine. The laboratory diagnostic techniques currently used, acid fast bacilli ( AFB) and culture, are slow and have sensitivities and specificities that need to be improved. The most promising technique for a fast and specific diagnosis is based on the polymerase chain reaction ( PCR) , which is theoretically capable of detecting one copy of DNA of any cell. This study was used the IS6110 repetitive element specific to MTB as the target for DNA amplification , and evaluate a PCR procedure by comparing it to smear and culture in patients with suspicious genitourinary tuberculosis.MethodsA total of 53 urine specimens from patients with ( positive controls) and without (negative controls) clinical symptoms and histological evidence of geni-tourinary tuberculosis ( TB) ( 10 cases, respectively), clinical symptoms of genitourinary TB suspected (33 cases) were tested in parallel by Ziehl - Neel-seen AFB smear, Lowenstein - Jensen culture and PCR techniques.ResultOur research reveals that in the patients within the controls, the sensitivity and specificity of PCR technique to Mycobacterium tuberculosis relative to histo-logical results, were 77. 8% and 100% ; culture were 44.4% and 100% ; AFB smear were 44.4% and 80% respectively. In the suspected patients, 10 (30. 3%) were positive by PCR. 6(18. 1%)/5(15. 1%) were positive by AFB smear and culture. From these, 20(60.6% ) were negative by the 3 methods, 2 (6.1% ) were smear positive and negative by culture and PCR,6 ( 18. 2% ) were both smear and culture negative , and PCR positive, 3 (9. 1% ) were positive by the 3 methods, 1(3%) were positive by smear and culture, and negative by PCR ,1 (3% ) were positive by culture and PCR, but smear negative. After the resolution of discrepancies in PCR results, the sensitivity and specificity for PCR. technique to Mycobacterium tuberculosis relative to L - J culture were 80% and 78.5%, respectively.ConclusionThese results confirm that this method, PCR, may be a sensitive and specific technique for M. tuberculosis detection occurring in both positive and negative smear and negative culture. With Ziehl - Neelseen AFB smear and Lowenstein - Jensen culture, PCR could improve the diagnosis of genitourinary tuberculosis.Part Two: An Detection of Mycobacterium tuberculosis in Renal Tissue by Z - N Stain and PCRBackgroundAlthough the final diagnosis of genitourinary tuberculosis still depends on find the Mycobacterium tuberculosis (MTB) in urine, the relation between MTB in urine and in renal tissue has not been reported. And if early tuberculosis renal injury was related with exist of MTB are not clear. The objectives of this study were to investigate the relation between early tuberculosis renal injury and MTB in renal tissue, and to evaluate the relationship between MTB in urine and in renal tissue.MethodsIn a controlled study, the same 33 patients suspected genitourinary TB were tested in parallel by Ziehl — Neelseen AFB stain and PCR techniques in renal tissue. The same methods were conducted in patients present genitourinary TB and the normal renal tissue.ResultOf 33 patients suspected genitourinary TB respectively, only 2 (6. 1%) had positive results for Ziehl — Neelseen AFB stain. The red wirelike bacteria were deposited in renal tubular epithelia. 8 out of 33 were positive by PCR. PCR had a positive accuracy of 24.2% , which was obviously higher than Ziehl - Neelseen AFB stain (6% ). We looked results of culture as golden standard, PCR had a sensitivity of 80% , and a specificity of 85.7% in detection of renal tissue MTB DNA.ConclusionThese results confirm that this method, PCR, may be a sensitive and specific technique for M. tuberculosis detection in renal tissue. Statistical analysis of results shows a significant relation has been found between the MTB in urine and MTB in renal tissue. The detection of MTB DNA in urine and renal tissue had a accordant accuracy of 90% in genitourinary tuberculosis group and 87.9% in suspected genitourinary TB group. MTB were or were not in renal tissue during early tuberculosis renal disease. We confer that early tuberculosis renal injury present another immune mechanism.Part Three: The Expression of Tuberculosis Antigen 85 in Renal TissueBackgroundWe identified the MTB were or were not in renal tissue during early tuberculosis renal injury. And some renal diseases were related with tuberculosis im-munoreactive syndrome. Some studies showed that circulating immune complex (CIC) was in the patients'serum of active tuberculosis, which had a high level of serum TB antigen 85 ( Ag 85 ) concentration. So these observations suggest that glomerular and tubulointerstitial lesions associated with tuberculosis could be related with immune mechanism. The objectives of this study were to investigate the relation between early tuberculosis renal injury and antigen 85 of MTB in renal tissue.MethodsIn a controlled study, the same 33 patients suspected genitourinary TB were tested in parallel by immunohistochemistry techniques for detecting MTB Ag 85 in renal tissue. The same methods were conducted in patients present genitourinary TB and the normal renal tissue.Result10 genitourinary TB patients were all positive. Normal controls were all negative. 12 out of 33 suspected genitourinary TB were positive by immunohistochemistry. This group had a diagnostic accuracy of 36.4% , which was higher than pathologic diagnosis. The positive depositions were in cytoplasm of mesang-...
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